Method for decreasing symptoms of alcohol consumption

ABSTRACT

The present invention relates to methods and compositions of metadoxine and physiologically compatible active derivatives thereof, and their use for decreasing symptoms of alcohol consumption as well as in the prevention of alcohol consumption related symptoms in subjects in need thereof.

This application is a continuation of U.S. patent application Ser. No.12/667,272, filed Jun. 23, 2010, which is a national stage filing under35 U.S.C. 371 of International Patent Application No. PCT/IL2008/000917,filed Jul. 3, 2008 and published under PCT Article 21(2) in English,which claims the benefit of Israeli Patent Application No. 184389, filedJul. 3, 2007 and of Israeli Patent Application No. 187159, filed Nov. 5,2007. The specification of each above-listed application is hereinincorporated by reference in its entirety.

FIELD OF THE INVENTION

The present invention relates to methods and compositions of metadoxineand functional, physiologically compatible derivatives thereof, andtheir use in decreasing symptoms of alcohol consumption as well as inthe prevention of alcohol consumption related symptoms in subjects inneed thereof.

BACKGROUND OF THE INVENTION

Social drinking (the consumption of alcohol without becomingintoxicated) is a social norm in many cultures and has long beenconsidered an acceptable practice which allows people to socialize morefreely and easily together. Drinking is relaxing for many people, anddrinking before and during parties, at bars or restaurants, with mealsand with family and friends are all acts considered to be within therealm of social drinking, when alcohol consumption is maintained so thatintoxication is not reached.

More excessive or serious forms of drinking, often chronic, may bepotentially harmful to the drinker and to others affected by thedrinker. For example, drinking with the intent to get drunk orintoxicated, drinking and driving while under the influence of alcohol,loss of psychomotor coordination and speech, blackouts, vomiting,alcohol poisoning and associated deaths are considered among the harmfulsymptoms and effects of drinking that falls outside the scope of socialdrinking. It would be desirable to avoid these and other effects orconsequences of excessive alcohol consumption.

Alcohol abuse, moreover, is a common problem in the general populationall over the world. Alcohol abuse and alcoholism are responsible for awide variety of medical problems, which are considered part of thenew-age epidemics, among them the most recognized being alcohol-inducedliver disease, primary and secondary malnutrition, and neuron damage,often leading to death.

The pharmaco-therapeutic aspect of alcoholism includes the use of drugs,with different actions and objectives. Metadoxine is apyridoxine-pyrrolidone carboxylate (also known as pyridoxolL,2-pyrrolidon-5 carboxylate or pyridoxine5-oxo-2-pyrrolidon-carboxylate) with significant alcohol scavengingproperties which has been used to treat acute alcohol intoxication,poisoning, and certain acute alcohol syndromes (reviewed in Addoloratoet al., Int. J. Immunopathol. Pharmacal. (2003) 16:207-214). Long termdata show that metadoxine is safe for use by humans.

Metadoxine is capable of accelerating the elimination of alcohol fromthe blood and tissues, helping restore the functional structure of theliver and relieve neuro-psychological disorders associated with chronicalcohol intoxication and associated syndromes. In animal studies,metadoxine increased plasma clearance and urinary excretion of ethanol,inhibited the increased production of fatty acid esters in the liverduring chronic alcohol intake, reduced oxidative stress and preventedglutathione depletion in hepatic tissues (Antonelli et al., Pharmacol.Res. Commun. (1984) 16:189-197). In the brain, metadoxine increased thelevel of GABA and acetylcholine in the frontoparietal cortex of guineapigs.

Metadoxine is an ion-pair between pyrrolidone carboxylate (PCA) andpyridoxine (vitamin B6) with the two compounds linked in a singleproduct by salification. The pairing with PCA synergistically increasesthe pharmacological activity of pyridoxine (see, e.g., U.S. Pat. No.4,313,952). Metadoxine is freely soluble in water and in gastric fluid.Oral absorption of the drug is fast with high bioavailability (60-80%).The half life of metadoxine in human serum is short (40-60 minutes)without appreciable differences between oral and intravenousadministration (Addolorato et al., supra; Lu Yuan et al., Chin. Med. J.2007 120(2) 160-168).

Metadoxine is marketed in several countries as a prescription drug inthe form of 500 mg tablets and 300 mg injections. Tablets contain 500 mgof metadoxine, microcrystalline cellulose and magnesium stearate.Ampoules contain 300 mg of metadoxine, sodium metabisulfite, EDTAsodium, methyl-p-hydroxybenzoate and water.

Maximal levels of ethanol appear in the blood stream 30-60 minutes afterdrinking. Due to the fast absorption of ethanol, stomach wash isineffective against ethanol overdose. Because ethanol is miscible inwater, it will be targeted to water-rich tissues, such as the brain,where it will cause the familiar symptoms. An average drink increasesblood ethanol level to about 20 mg/dl, which can typically bemetabolized and cleared in about one hour. Up-regulation ofalcohol-dehydrogenase (ADH) in heavy drinkers may increase the ethanolclearance to about 30 mg/dl per hour.

There is thus a need for methods and compositions that are capable ofquickly reducing alcohol levels and providing quick restoration ofsobriety following alcohol consumption in any type of drinking, or thatreduce or prevent symptoms of alcohol consumption, particularly insubjects that have not reached intoxication levels or who do not exhibitsymptoms of chronic alcoholic related syndromes. It would be desirable,for example, to have a treatment which could be administered during orshortly after social drinking of any amount of alcohol that would enablethe drinker to quickly become sober enough to legally drive. There isalso a need for better treatment and prevention of acute and chronicalcohol intoxications and related diseases, such as alcoholism.

SUMMARY OF THE INVENTION

The present invention solves one or more of the problems referred toabove by providing various methods for reducing or preventing effects ofalcohol consumption by administering a metadoxine composition.Metadoxine compositions formulated for sustained or controlled release,optionally also including an immediate release component, and methodsfor using such sustained or controlled release metadoxine formulationsof the invention, are also provided.

Accordingly, in certain aspects, the invention provides a method fordecreasing or preventing symptoms or effects of alcohol consumption in asubject in need thereof, preferably wherein the subject has not reachedintoxication, comprising administering a composition comprisingmetadoxine.

In certain aspects, the invention provides a method for preventingalcohol intoxication in a subject in need thereof, comprisingadministering a composition comprising metadoxine.

In certain aspects, the invention provides a method for reducing oreliminating blood alcohol levels in a subject in need thereof,preferably wherein the subject has not reached intoxication, comprisingadministering a composition comprising metadoxine.

In certain other aspects, the invention provides a compositioncomprising metadoxine formulated for sustained release or controlledrelease. In some aspects, the invention provides a compositioncomprising metadoxine, wherein a portion of the metadoxine is formulatedfor sustained or controlled release and a portion of the metadoxine isformulated for immediate release.

Accordingly, in any of the various embodiments of the methods of theinvention described above, the composition may comprise metadoxineformulated for immediate release, sustained release, controlled release,or a combination of any of the foregoing. In any of the variousembodiments of the above described methods, the administration isnon-chronic administration. Moreover, the metadoxine may consist of orcomprise a physiologically compatible metadoxine derivative as describedherein.

In certain other aspects, the invention provides a method for increasingthe mean t_(max) of metadoxine in the blood of a subject in need thereofcomprising administering a metadoxine composition of the inventionformulated for sustained release or controlled release, optionallyincluding a portion of the metadoxine formulated for immediate release.

In certain aspects, the invention provides a use of any one of thecompositions of the invention in the manufacture of a therapeuticcomposition useful for practicing each of the methods of the inventionas described herein, e.g., for reducing or preventing symptoms oreffects of alcohol consumption; for preventing alcohol intoxication; forreducing or eliminating blood alcohol levels in a subject, or forincreasing the mean t_(max) of metadoxine in the blood of a subject,among others.

In any of the various embodiments of metadoxine compositions describedherein (e.g., metadoxine formulated for immediate release, sustainedrelease, controlled release, or a combination of any of the foregoing),the metadoxine may consist of or comprise a physiologically compatiblemetadoxine derivative, as described herein. In certain embodiments,metadoxine compositions are formulated for non-chronic administration,and preferably for non-invasive administration.

The present invention also provides delivery devices and kits comprisinga metadoxine composition of the invention, and methods for their use inthe treatment or prevention of alcohol consumption related symptoms.Kits may optionally include means for measuring or monitoring bloodalcohol concentration (BAC) levels before, during or afteradministration of a metadoxine composition.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 shows a graph of the rate of release of certain metadoxinecompositions of the present invention as described in Examples 2-3. Thegraph illustrates the difference between an immediate releaseformulation and a slow release formulation of metadoxine. Metadoxine (%)released vs. time (hours).

FIG. 2 illustrates exemplary dissolution rates of various slow releasemetadoxine formulations prepared using different polymers as describesin Examples 4-6. Metadoxine (%) released vs. time (hours).

FIG. 3 illustrates metadoxine mean serum levels in 3 pigs afteradministration of immediate release and slow release formulations asdescribed in Example 13. Metadoxine mean serum levels (micrograms(mcg)/ml) vs. time (hours).

FIG. 4 illustrates metadoxine mean serum levels in 3 pigs afteradministration of a slow release metadoxine formulation (250 mg) anddouble dose (500 mg) slow release metadoxine formulations as describedin Example 13. Metadoxine mean serum levels (mcg/ml) vs. time (hours).

DESCRIPTION OF THE INVENTION

Definitions

For convenience, certain terms employed in the specification, examples,and appended embodiments, are collected here. Unless defined otherwise,all technical and scientific terms used herein have the same meaning ascommonly understood by one of ordinary skill in the art to which thisinvention belongs.

The articles “a” and “an” are used herein to refer to one or to morethan one (i.e., to at least one) of the grammatical object of thearticle. By way of example, “an element” means one element or more thanone element.

The term “including” is used herein to mean, and is used interchangeablywith, the phrase “including but not limited to”.

The term “or” is used herein to mean, and is used interchangeably with,the term “and/or,” unless context clearly indicates otherwise.

The term “such as” is used herein to mean, and is used interchangeably,with the phrase “such as but not limited to”.

The term “prophylactic” or “therapeutic” treatment refers toadministration to a subject of one or more of the compositions of theinvention. If it is administered prior to clinical manifestation of theunwanted condition (e.g., disease or other unwanted state of the hostanimal) then the treatment is prophylactic, i.e., it contributes toprevention of, i.e., protection of the subject against developing anunwanted condition, whereas if administered after manifestation of anunwanted condition, the treatment is therapeutic (i.e., it is intendedto diminish, ameliorate or prevent progression of the unwanted conditionor side effects therefrom).

The term “therapeutic effect” refers to a local or systemic effect inanimals, particularly mammals, and more particularly humans, caused by apharmacologically active substance or substances. The term thus meansany substance intended for use in diagnosis, cure, mitigation, treatmentor prevention of disease or in the enhancement of desirable physical ormental development and conditions in an animal or human. The term“therapeutically effective amount” means that amount of such a substancethat produces some desired local or systemic effect at a reasonablebenefit/risk ratio applicable to any treatment. In certain embodiments,a therapeutically-effective amount of a compound or composition willdepend on its therapeutic index, solubility, and the like. For example,certain metadoxine formulations of the present invention may beadministered in a sufficient amount to produce a reasonable benefit/riskratio applicable to a selected treatment, as may be determined by theskilled artisan.

The term “effective amount” refers to the amount of a therapeuticreagent that when administered to a subject in an appropriate dose andregimen produces at least one desired result.

A “subject” or “patient” to be treated by a method of the invention maymean either a human or non-human animal, preferably a mammal.

Throughout this specification, the word “comprise” or variations such as“comprises” or “comprising” will be understood to imply the inclusion ofa stated integer or groups of integers but not the exclusion of anyother integer or group of integers.

The term “bioavailable” means that at least some amount of a particularcompound is present in the systemic circulation. Formal calculations oforal bioavailability are described in terms of an F value (“Fundamentalsof Clinical Pharmacokinetics,” John G. Wegner, Drug IntelligencePublications; Hamilton, Ill. 1975). F values are derived from the ratioof the concentration of the parent drug in the systemic circulation(e.g., plasma) following intravenous administration to the concentrationof the parent drug in the systemic circulation after administration by anon-intravenous route (e.g., oral). Therefore, oral bioavailabilitywithin the scope of the present invention contemplates the ratio or Fvalue of the amount of parent drug detectable in the plasma after oraladministration compared to intravenous administration.

The term “treating” or “treatment” refers to mitigating or alleviatingat least on symptom of a condition, disease or disorder in a mammal,such as a human, or the improvement of an ascertainable measurementassociated with a condition, disease or disorder.

The term “metadoxine” as used herein refers to the currently known andavailable form of metadoxine, which is an ion-pair between pyrrolidonecarboxylate (PCA) and pyridoxine (vitamin B6) with the two compoundslinked in a single product by salification. The term “metadoxine” asused herein is also intended to refer to and encompass any other activeform of pyrrolidone carboxylate (PCA) in stable association withpyridoxine (vitamin B6). Stable association between the PCA andpyridoxine may be non-covalent, such as through a salt link, or otherhydrostatic or electrostatic forces. Stable association, in other cases,may be accomplished by covalent bonding, e.g., by means of a linker orother chemical bond between the PCA and pyridoxine in which metadoxineactivity is retained. The skilled artisan will be able to test thebiological activity of any such complexes in standard metadoxine assays.

The term “acceptable derivative” with respect to metadoxine refers toany salt, conjugate, ester, complex or other chemical derivative ofmetadoxine or any of the moieties comprising the same, which, uponadministration to a subject, is capable of providing (directly orindirectly) metadoxine or a metabolite or functional residue thereof, ormeasurable metadoxine activity. The term “physiologically compatiblemetadoxine derivative” may be used interchangeably herein with the term“acceptable derivative” and refers to a functional, active,pharmaceutically acceptable derivative of metadoxine.

The term “excipient” refers to an inactive substance used as a carrierfor the active ingredient in a formulation.

The term “controlled release” refers to any formulation which deliversan agent at a controlled rate for an extended time and is designed toachieve a desired agent level profile.

The term “sustained release” is used in its conventional sense to referto a formulation that provides for gradual release of an active materialover an extended period of time, which in certain embodiments may alsofurther result in substantially constant blood levels over an extendedtime period, i.e., controlled release.

The term “immediate release” is used in its conventional sense to referto a formulation that provides for non delayed or controlled release ofan active material upon administration.

The term “half-life” of a substance is the time it takes for a substanceto lose half of its pharmacologic, physiologic, or other activity.Biological half-life is an important pharmacokinetic parameter and isusually denoted by the abbreviation t_(1/2).

The term “non-invasive” refers to modes of treatment which do notpuncture the skin.

The term “non-chronic administration” may be used interchangeably hereinwith the term “acute administration” and refers to giving a measured ornon-measured quantity or portion of a medication to a subject on anon-regular basis. Non-chronic administration may be a single dosetreatment or a multiple dose treatment, and may optionally be given overtime. Typically but not always, a non-chronic administration is given totreat or prevent a non-chronic condition. Certain chronic conditions mayalso benefit from non-chronic administration of a metadoxine compositiondescribed herein.

The term “chronic administration” refers to giving a measured quantityof a medication on a regular basis to a subject. In some embodiments,chronic administration is to treat or prevent one or more chronicconditions or diseases. Chronic diseases have one or more of thefollowing characteristics: they are permanent, leave residualdisability, are caused by nonreversible pathological alteration, requirespecial training of the patient for rehabilitation, or may be expectedto require a long period of supervision, observation, or care.

The term “single dose treatment” refers to giving a measured quantity ofa medication to be taken at one time. It is given to treat non-chronicconditions on an irregular basis, depending on personal need.

The term “alcoholism” refers to a primary chronic disease known asalcohol dependence syndrome, the most severe stage of a group ofdrinking problems. Alcoholism is considered a progressive disease,meaning that the symptoms and effects of drinking alcohol becomeincreasingly more severe over time (Morse R. et al., JAMA 268(8):1012-4(1992)).

The term “alcohol abuse” refers to repeated drinking despitealcohol-related physical, social, psychological, or occupationalproblems (The Diagnostic and Statistical Manual of Mental Disorders,IV). When alcohol abuse reaches the alcohol dependence stage, the personmay also experience tolerance, withdrawal, and an uncontrolled drive todrink.

Art-recognized symptoms of alcohol consumption include: reduced activityin the central nervous system, loose muscle tone, loss of fine motorcoordination, a staggering “drunken” gait, eyes appear “glossy,” pupilsmay be slow to respond to stimulus, pupils may become constricted,decreased heart rate, lower blood pressure and respiration rate,decreased reflex responses, slower reaction times, skin may be cool tothe touch (but the user may feel warm), profuse sweating, loss of finemotor coordination, or odor of alcohol on the breath. Symptoms ofalcohol consumption and diagnostic criteria for alcohol intoxicationinclude those described in the Diagnostic and Statistical Manual ofMental Disorders DSM-IV, e.g., section 303.00 Diagnostic Criteria forAlcohol Intoxication.

The term “alcohol intoxication” as used herein refers to a situationwhere the quantity of alcohol a person consumes exceeds the individual'stolerance for alcohol and produces, either during or shortly afterdrinking, clinically important psychological, behavioral or physicalabnormalities, such as inappropriate aggression, and impaired judgmentand social functioning. One or more of the following signs or symptomsof alcohol intoxication occur shortly after drinking: (1) slurredspeech; (2) impaired motor coordination; (3) unsteady gait; (4)nystagmus (involuntary, irregular eye movement characterized by smoothpursuit of an object in one direction and saccadic movement in the otherdirection); (5) inattention and/or impaired memory; and (6) stupor orcoma (see Diagnostic and Statistical Manual of Mental Disorders, FourthEdition, (DSM-IV) 303.00).

Sobriety, intoxication, alcohol abuse, alcohol-related aggression oralcoholism may be measured according to one or more art recognizedtests, such as psychomotor texts, serum alcohol level tests, for exampleaccepted inhalation tests, Diagnostic and Statistical Manual of MentalDisorders, Fourth Edition, (DSM-IV), Alcohol Abstinence Self-EfficacyScale (AASE; DiClemente, Carbonari, Montgomery, and Hughes, 1994),Barratt Impulsiveness Scale—11 (BIS-11; Barratt, 1994), State-TraitAnger Expression Inventory—2 (STAXI-2; Spielberger, 1999), ConflictResolution, Impulsivity and Aggression Questionnaire (CRIAQ; Honess,Maguire, and Vanstone, 2001), Social Problem-Solving Inventory—Revised(SPSI-R; D'Zurilla, Nezu, and Maydeu-Olivares, 2002), Alcohol-RelatedAggression Questionnaire (ARAQ; McMurran, Egan, Austin, andCharlesworth, under review), or The Alcohol Use Disorders IdentificationTest (AUDIT; Saunders, Aasland, Babor, et al., 1993). Levels of alcoholin the body may be measured in urine, blood, breath or saliva.

There is a wide range of variability in blood alcohol levels thatdifferent individuals can tolerate without becoming intoxicated. Therange may be as great as from 0.3 to 1.5 mg/ml, although most states inthe U.S. set the sobriety level for legally driving at 0.8 mg/ml(DSM-IV, 303.00; supra). Some users may develop significant behavioralchanges or become intoxicated at a much lower Blood AlcoholConcentration (BAC) than the legal limit. This condition is known as“Alcohol Idiosyncratic Intoxication” or “Pathological Intoxication”(DSM-IV, 291.9) In general, however, the following symptoms areassociated with increasing BAC levels:

-   -   0.02-0.03 BAC: No loss of coordination, slight euphoria and loss        of shyness. Depressant effects are not apparent.    -   0.04-0.06 BAC: Feeling of well-being, relaxation, lower        inhibitions, sensation of warmth. Euphoria. Some minor        impairment of reasoning and memory, lowering of caution.    -   0.07-0.09 BAC: Slight impairment of balance, speech, vision,        reaction time, and hearing. Euphoria. Judgment and self-control        are reduced, and caution, reason and memory are impaired.    -   0.10-0.125 BAC: Significant impairment of motor coordination and        loss of good judgment. Speech may be slurred; balance, vision,        reaction time and hearing will be impaired. Euphoria. It is        illegal to operate a motor vehicle at this level of        intoxication.    -   0.13-0.15 BAC: Gross motor impairment and lack of physical        control. Blurred vision and major loss of balance. Euphoria is        reduced and dysphoria (anxiety, restlessness) is beginning to        appear.    -   0.16-0.20 BAC: Dysphoria predominates, nausea may appear. The        drinker has the appearance of a “sloppy drunk.”    -   0.25 BAC: The drinker needs assistance in walking; total mental        confusion. Dysphoria with nausea and some vomiting.    -   0.30 BAC: Loss of consciousness.    -   0.40 BAC and up: Onset of coma, possible death due to        respiratory arrest.

The term “social drinking” refers to the consumption of alcohol in asafe, legal and socially acceptable manner usually without the intent ofreaching the point of becoming intoxicated (i.e., to achieve alcoholintoxication). Although the amount of blood alcohol which leads tointoxication varies widely between individuals, three or fewer measureddrinks (or a blood alcohol level of up to 0.05%) is generally consideredto be within the social drinking range.

The term “session drinking” refers to drinking in large quantities overa single period of time, or session, without the intention of gettingheavily intoxicated. The focus is on the social aspects of the occasion.

The term “binge drinking” refers to drinking alcohol solely for thepurpose of intoxication, although it is quite common for binge drinkingto apply to a social situation, creating some overlap in social andbinge drinking. In certain embodiments, binge drinking refers to a womanconsuming four drinks and a man consuming five drinks on a singledrinking occasion. Because drinking occasions can last up to five orseven hours, many such bingers never become intoxicated.

The term “t_(max)” refers to the time to peak concentration. Calculationof time at which maximum concentration occurs after a single doseadministration is performed according to the formula:

$t_{\max} = {\frac{2.303}{\lambda_{a} - \lambda_{z}}\log\frac{\lambda_{a}}{\lambda_{z}}}$where λ_(a) and λ_(z) are the apparent absorption and elimination rateconstants, respectively.Methods of Treatment and Prevention Using Metadoxine Compositions

In certain embodiments, the present invention provides a method fordecreasing or preventing symptoms or effects of alcohol consumption in asubject in need thereof, especially wherein the subject has not reachedintoxication, comprising administering a composition comprisingmetadoxine or a physiologically acceptable derivative thereof. Incertain such embodiments, the method comprises non-chronicadministration of a composition comprising metadoxine or aphysiologically acceptable derivative thereof.

In certain embodiments, the present invention provides a method forpreventing alcohol intoxication in a subject in need thereof, comprisingadministering a composition comprising metadoxine or a physiologicallyacceptable derivative thereof. In certain such embodiments, the methodcomprises non-chronic administration of a composition comprisingmetadoxine or a physiologically acceptable derivative thereof. Incertain embodiments, methods for preventing intoxication includetreatment of a subject with a composition comprising metadoxine or aphysiologically acceptable derivative thereof, wherein the subject haspreviously reached intoxication and has subsequently sobered to a levelthat is below intoxication during a single drinking session.

In certain embodiments, the present invention provides a method forpreventing alcoholism in a subject in need thereof, especially when thesubject is not an acute alcoholic, comprising administering acomposition comprising metadoxine or a physiologically acceptablederivative thereof.

In certain embodiments, the present invention provides a method forslowing the progression of alcoholism in a subject in need thereof,especially when the subject is not an acute alcoholic, comprisingadministering a composition comprising metadoxine or a physiologicallyacceptable derivative thereof.

In certain embodiments, the present invention provides a method forreducing or eliminating blood alcohol levels in a subject in needthereof, especially wherein the subject has not reached intoxication,comprising administering a composition comprising metadoxine or aphysiologically acceptable derivative thereof. In certain suchembodiments, the method comprises non-chronic administration of acomposition comprising metadoxine or a physiologically acceptablederivative thereof.

In certain embodiments, the present invention provides a method forincreasing the mean t_(max) of metadoxine in the blood of a subject inneed thereof comprising administering a composition comprisingmetadoxine or a physiologically acceptable derivative thereof, andespecially wherein the composition comprises metadoxine or aphysiologically acceptable derivative thereof formulated in whole or inpart for sustained or controlled release. In certain such embodiments,the method comprises non-chronic administration of a compositioncomprising metadoxine or a physiologically acceptable derivative thereofformulated in whole or in part for sustained or controlled release. Incertain embodiments of the invention, the mean t_(max) of metadoxine inthe blood of a subject is increased by 50%, 100%, 150%, 200%, 300%, 400%500% or greater than 500%.

In certain embodiments, the application provides a method for increasingthe half-life (t_(1/2)) of metadoxine in the blood or serum of a subjectin need thereof comprising administering a composition comprisingmetadoxine or a physiologically acceptable derivative thereof, andespecially wherein the composition comprises metadoxine or aphysiologically acceptable derivative thereof formulated in whole or inpart for sustained release or controlled release, optionally including aportion of the metadoxine formulated for immediate release. In certainembodiments of the invention, the t_(1/2) of metadoxine in the blood orserum of a subject is increased by 50%, 100%, 150%, 200%, 300%, 400%500% or greater than 500%.

In certain embodiments of the invention, metadoxine or a physiologicallyacceptable derivative thereof is used for immediate relief ofdrunkenness and regaining of sobriety in a subject in need thereof. Insome embodiments, the subject has not reached alcohol intoxicationlevels. Such immediate relief has a great value in preventing varioushazards, particularly motor vehicle accidents and other personalinjuries. In certain such embodiments, the method comprises non-chronicadministration of a composition comprising metadoxine or aphysiologically acceptable derivative thereof, and may optionally beformulated in whole or in part for sustained or controlled release.

In certain embodiments, metadoxine or a physiologically acceptablederivative thereof is used for prolonged relief of drunkenness andregaining of sobriety in a subject in need thereof. In some embodiments,the subject has not reached alcohol intoxication levels. As above, suchprolonged relief has a great value in preventing various hazards,particularly motor vehicle accidents and other personal injuries andalso has a value in preventing and treating various symptoms andconditions associated with prolonged or frequent alcohol consumption. Incertain such embodiments, the method comprises non-chronicadministration of a composition comprising metadoxine or aphysiologically acceptable derivative thereof, and may be optionallyformulated in whole or in part for sustained or controlled release.

In certain embodiments, methods of the present invention may be used totreat a subject that has consumed alcohol but is not intoxicated. Incertain embodiments, the methods of the invention may be used to treat asubject that has consumed alcohol but has not had an increase inpsychomotor excitation and aggression. The methods of the presentinvention are intended for use in a variety of subjects before, duringor after a variety of types of alcohol consumption of any amount. Aseach subject will present with different symptoms of alcoholconsumption, blood alcohol concentrations alone are often useful butinsufficient taken alone to describe subjects that will benefit from thecompositions and methods of the present invention.

In certain embodiments, metadoxine compositions of the invention, e.g.,formulated in whole or in part for sustained or controlled release,enable more efficient use of metadoxine in the treatment or preventionof non-chronic or chronic alcohol intoxications and syndromes andconditions related thereto.

In certain embodiments, the methods of the present invention may be usedto prevent alcohol consumption related symptoms. In certain embodiments,subjects are treated before any alcohol consumption. In certainembodiments, subjects are treated after alcohol consumption, but beforesymptoms occur. In certain embodiments, subjects are treated afteralcohol consumption, but before subjects are intoxicated. Theseembodiments are not mutually exclusive and may be combined in anydesired combination.

In certain embodiments, the methods of the invention may preventsymptoms of alcohol consumption related to drinking one drink or aportion thereof. In certain embodiments, the methods of the inventionmay prevent symptoms of alcohol consumption related to drinking 2, 3, 4,5 or more drinks.

In a yet further embodiment, the invention provides a method for therapid or immediate restoration of sobriety following alcohol consumptionin a subject in need of such treatment, comprising administering to saidsubject a composition comprising metadoxine or a physiologicallyacceptable derivative thereof. In certain embodiments, the subject hasnot reached alcohol intoxication levels. In certain embodiments, theadministration is a non-chronic administration.

Furthermore, the invention provides a method of treatment and/orprevention of alcohol intoxication in a subject in need of suchtreatment, comprising administering to said subject a compositioncomprising metadoxine or a physiologically acceptable derivativethereof. In certain embodiments, the subject has not reached alcoholintoxication levels. In certain embodiments, the administration is anon-chronic administration.

Still further, the invention relates to a method of reducing alcoholblood, serum or tissue levels (e.g., muscle and other non-adiposetissues) in a subject in need of such treatment, comprisingadministering to said subject a composition comprising metadoxine or aphysiologically acceptable derivative thereof. In certain embodiments,the subject has not reached alcohol intoxication levels. In certainembodiments, the administration is a non-chronic administration.

In certain embodiments, the invention provides a method of reducing orpreventing an increase in BAC in a subject who is or has been consumingalcohol. In certain embodiments, the methods of the present inventionmay decrease or prevent an increase in BAC so that the subject has a BACthat is legally low enough to permit the subject to operate a motorvehicle. In certain embodiments, the compositions of the invention mayprevent an increase in BAC beyond 1, 2, 3, or more levels as describedin the definitions above. In certain embodiments, the compositions ofthe present invention may decrease BAC. In certain embodiments, themethods of the present invention may decrease BAC to a level whereoperating a motor vehicle is legally permitted. In certain embodiments,the compositions of the invention may decrease BAC by 1, 2, 3 or morelevels as described in the definitions above.

In certain of the above described methods of the invention, themetadoxine or acceptable derivative thereof may be formulated forimmediate release upon administration to the subject. In certain of theabove described methods of the invention, the metadoxine or acceptablederivative thereof may be formulated for sustained and/or controlledrelease, and may optionally be formulated to have both immediate releaseand sustained and/or controlled release characteristics uponadministration to the subject. In certain embodiments, metadoxine or aphysiologically acceptable derivative thereof is formulated fornon-chronic administration. Metadoxine formulations of the invention aredescribed in more detail below.

Metadoxine Formulations and Administration Regimens

In certain embodiments, the present invention provides a compositioncomprising metadoxine or a physiologically acceptable derivative thereofformulated for sustained and/or controlled release when administered toa subject.

In certain embodiments, the present invention provides a compositioncomprising metadoxine or a physiologically acceptable derivative thereofwherein a portion of the metadoxine or derivative is formulated forsustained and/or controlled release and a portion of the metadoxine orderivative is formulated for immediate release when administered to asubject.

In certain embodiments, a metadoxine composition may decrease symptomsof alcohol consumption related to drinking one drink or a portionthereof. In certain embodiments, a metadoxine composition may decreasesymptoms of alcohol consumption related to drinking 2, 3, 4, 5 or moredrinks.

In certain embodiments, a metadoxine composition may be delivered in asingle dose form, such as in a single dose drink. In certainembodiments, the compositions of the invention may be delivered in asingle dose per drinking session. In certain embodiments, a metadoxinecomposition may be delivered in a single dose per binge drinkingsession. In certain embodiments, a metadoxine composition may bedelivered in a single dose per acute alcohol related condition orpotential condition. In certain embodiments, a metadoxine compositionmay be delivered in a single dose form per intoxication or potentialintoxication. A potential condition or intoxication may be a state thatwould lead to the condition or intoxication without intervention. Incertain embodiments, a single dose may be a partial dose, i.e., aportion of a single dosage form.

In certain embodiments, metadoxine compositions may be administered 24hours, 12 hours, 8 hours, 4 hours, 2 hours, one hour, 55 minutes, 50minutes, 45 minutes, 40 minutes, 35 minutes, 30 minutes, 25 minutes, 20minutes, 15 minutes, 10 minutes, 5 minutes or immediately before alcoholconsumption.

In certain embodiments, metadoxine compositions may be administered 24hours, 12 hours, 8 hours, 4 hours, 2 hours, one hour, 55 minutes, 50minutes, 45 minutes, 40 minutes, 35 minutes, 30 minutes, 25 minutes, 20minutes, 15 minutes, 10 minutes, 5 minutes or immediately before alcoholrelated symptoms occur.

In certain embodiments, metadoxine compositions may be administered 24hours, 12 hours, 8 hours, 4 hours, 2 hours, one hour, 55 minutes, 50minutes, 45 minutes, 40 minutes, 35 minutes, 30 minutes, 25 minutes, 20minutes, 15 minutes, 10 minutes, 5 minutes or immediately after alcoholconsumption.

In certain embodiments, metadoxine compositions may be administered 24hours, 12 hours, 8 hours, 4 hours, 2 hours, one hour, 55 minutes, 50minutes, 45 minutes, 40 minutes, 35 minutes, 30 minutes, 25 minutes, 20minutes, 15 minutes, 10 minutes, 5 minutes or immediately after alcoholrelated symptoms occur.

In certain embodiments, metadoxine compositions may be administeredhourly, daily, weekly, monthly, yearly (e.g., in a time release form) oras a one-time delivery. The administration may be chronic ornon-chronic. In certain embodiments, the delivery is not continuous. Incertain embodiments, a metadoxine composition may be delivered in asingle dose. In certain embodiments, the administration is once, twice,three times or more within a 12- to 24-hour period at which time thetreatment is discontinued. In certain embodiments, the administration isonce, twice, three times or more within a 24- to 48-hour period at whichtime the treatment is discontinued. In certain embodiments, the mode ofdelivery is non-invasive. In certain embodiments, the delivery is notintravenous.

In certain embodiment, the delivery may be continuous delivery for aperiod of time, e.g., intravenous delivery. In one embodiment of themethods described herein, the metadoxine composition is administered atleast once per hour. In one embodiment of the methods described herein,the metadoxine composition is administered hourly. In one embodiment ofthe methods described herein, the metadoxine composition is administeredat least once per day. In one embodiment, the metadoxine composition isadministered daily. In one embodiment, the metadoxine composition isadministered every other day. In one embodiment, the metadoxinecomposition is administered every 6 to 8 days, or more specifically,weekly.

In certain embodiments, effective serum levels of the active ingredientare achieved within from about 10 to about 20 or 30 or 40 or 50 or 60minutes following metadoxine administration. In certain embodiments,effective serum levels of the active ingredient are achieved within fromabout 5 to about 20 or 30 or 40 or 50 or 60 minutes following metadoxineadministration. In certain embodiments, effective serum levels of theactive ingredient are achieved within from about 20 to about 20 or 30 or40 or 50 or 60 minutes following metadoxine administration. In certainembodiments, effective serum levels of the active ingredient areachieved within about 5, 10, 15, 20, 30, 40, 50 or 60 minutes.

In certain embodiments, relief or decrease or prevention of alcoholrelated symptoms are achieved within from about 5 to about 20 or 30 or40 or 50 or 60 minutes following metadoxine administration. In certainembodiments, relief or decrease or prevention of alcohol relatedsymptoms are achieved within from about 10 to about 20 or 30 or 40 or 50or 60 minutes following metadoxine administration. In certainembodiments, relief or decrease or prevention of alcohol relatedsymptoms are achieved within from about 15 to about 20 or 30 or 40 or 50or 60 minutes following metadoxine administration.

In certain embodiments, relief or decrease or prevention of alcoholrelated symptoms are achieved within from about one hour to about 2, 3,4, 5, 6, 7 or 8 hours following metadoxine administration. In certainembodiments, relief or decrease or prevention of alcohol relatedsymptoms are achieved within from about 2 hours to about 3, 4, 5, 6, 7or 8 hours following metadoxine administration. In certain embodiments,relief or decrease or prevention of alcohol related symptoms areachieved within from about 3 hours to about 4, 5, 6, 7 or 8 hoursfollowing metadoxine administration. In certain embodiments, relief ordecrease or prevention of alcohol related symptoms are achieved withinfrom about 4 hours to about 5, 6, 7 or 8 hours following metadoxineadministration. In certain embodiments, relief or decrease or preventionof alcohol related symptoms are achieved within from about 5 hours toabout 6, 7 or 8 hours following metadoxine administration. In certainembodiments, relief or decrease or prevention of alcohol relatedsymptoms are achieved within from about 6 hours to about 7 or 8 hoursfollowing metadoxine administration. In certain embodiments, relief ordecrease or prevention of alcohol related symptoms are achieved withinfrom about 7 to about 8 hours following metadoxine administration.

In certain embodiments, relief or decrease or prevention of alcoholrelated symptoms are achieved within about 5, 10, 15, 20, 30, 40, 50 or60 minutes following metadoxine administration. In certain embodiments,relief or decrease or prevention of alcohol related symptoms areachieved within about 2, 3, 4, 5, 6, 7 or 8 hours following metadoxineadministration.

In certain embodiments, the therapeutic effective amount, or dosage, maybe dependent on the amount of alcohol consumed or to be consumed, stateof intoxication, severity and responsiveness of the subject, or whetherthere is to be chronic or acute treatment. The course of metadoxinetreatment may last from a few minutes to several days to several months,or until a cure is effected or a diminution of the symptom, condition ordisease state is achieved. The treatment regimen selected may be chronicor non-chronic. Optimal dosing schedules may be calculated frommeasurements of drug accumulation in the body of the patient. Persons ofordinary skill can easily determine optimum dosages, dosingmethodologies and repetition rates. In general, dosage is calculatedaccording to body weight, and may be given once or more daily, weekly,monthly or yearly, or even once every 2 to 20 years. Persons of ordinaryskill in the art can easily estimate repetition rates for dosing basedon measured residence times and concentrations of the combinedcomposition of the invention in bodily fluids or tissues. Followingsuccessful treatment, it may be desirable to have the patient undergomaintenance therapy to prevent the recurrence of the disease state,wherein the combined composition of the invention is administered inmaintenance doses, once or more daily.

The present inventors have developed innovative approaches for theadministration of metadoxine based on enteral (via the digestive tract)and/or parenteral (other routes than digestive tract) routes. Theseapproaches provide for a rational design of delivery systems withdesired properties based on the meticulous selection of the carrier,e.g. appropriate surfactants/co-surfactants composition or micro/nanoparticles (such as liposomes or nano-liposomes) entrapping the activeingredients, or other additives or excipients, for the delivery systemof interest.

The enteral delivery systems may be designed for oral administration(tablets, sachets, lozenges, capsules, gelcaps, drops, or otherpalatable form) or rectal administration (suppository or (mini) enemaform).

In addition, the delivery system of interest may be in liquid form, forexample a drop solution, syrup. Furthermore, the delivery system ofinterest may be in form of a beverage or food article. Thus, the activeingredient/s used by the invention may be comprised in a beverage,particularly soft drinks like juices, nectars, water, sparkling waterand other sparkling drinks, shakes, milk shakes and other milk-baseddrinks, and the like. Liquid preparations may also be in the form ofconcentrated syrups, for diluting with water or sparkling water.Alternatively, the active ingredient/s may be comprised in foodarticles, such as snack bars, health bars, biscuits, cookies, sweets,confectionery products, ice creams, ice lollies, and the like.

Still further, the invention relates to a food or beverage articlecomprising a physiologically active pyridoxine derivative, particularlypyridoxol L,2-pyrrolidon-5 carboxylate (metadoxine), for fastrestoration of sobriety following alcohol consumption in a subject inneed thereof, especially wherein the subject has not reachedintoxication. In certain embodiments, consumption of the food orbeverage article of the invention may lead to achievement of serumlevels of the active ingredient within from about 10 to about 40-60minutes following consumption thereof.

The parenteral ways include subcutaneous, transdermal (diffusion throughthe intact skin), transmucosal (diffusion through a mucous membrane),sublingual, buccal (absorbed through cheek near gumline) administration,or administration by inhalation. In certain embodiments, thecompositions of the invention are not administered by invasive modes oftreatment (i.e., are non-invasive). In certain embodiments, themetadoxine compositions are not administered by intravenous injection.

In certain embodiments, compositions of the invention are delivered as amicrocrystalline powder or a solution suitable for nebulization; forintravaginal or intrarectal administration, pessaries, suppositories,creams or foams. A preferred formulation is a formulation for oraladministration. Another preferred formulation is for topicaladministration. Another preferred formulation is for transmucosaladministration, sublingual, buccal (absorbed through cheek near gumline)administration, administration by inhalation or ocular administration,e.g., in eye drops.

Administration of metadoxine for medical uses requires safe andefficient delivery systems. The present invention provides deliverysystems for safe delivery of a variety of substances due to theirspecial physico-chemical features, particularly direct absorption, bynon-invasive means, and consequent avoidance of side effects. Thedelivery systems significantly enhance efficiency and quality ofmetadoxine absorption based on its unique physicochemical features,which enables lower concentrations or amounts of active substance to bedelivered to a subject in a biologically active form. The deliverysystems of the invention provide for the direct access of the activesubstance to the tissues and thus provide immediate or near-immediateeffects of metadoxine to the subject in need thereof.

Accordingly, in certain embodiments, the present invention provides anon-invasive pharmaceutical delivery system for the improvedadministration of a physiologically active pyridoxine, particularlypyridoxol L,2-pyrrolidon-5 carboxylate (metadoxine), or aphysiologically acceptable derivative thereof, comprising as the activeingredient said physiologically active pyridoxine in a suitable carrierfor fast restoration of sobriety following alcohol consumption in asubject in need thereof, particularly wherein the subject has notreached intoxication. In certain embodiments, serum levels of the activeingredient are achieved within from about 10 to about 40-60 minutesfollowing administration.

In another embodiment, the invention provides a non-invasivepharmaceutical delivery system for the improved administration of aphysiologically active pyridoxine derivative, particularly pyridoxolL,2-pyrrolidon-5 carboxylate (metadoxine), for use in preventing ortreating chronic and/or acute alcohol intoxication in a subject in needthereof, comprising as the active ingredient said pyridoxine derivative,in a suitable carrier. In certain embodiments, serum levels of saidactive ingredient are achieved within from about 10 to about 40-60minutes following administration.

In certain embodiments, the drug delivery systems of the invention maybe designed for oral, nasal, ocular, rectal, subcutaneous, transdermal,transmucosal, sublingual, buccal or inhalation administration. The drugdelivery systems may provide the active substance in a controlledrelease mode. In certain embodiments, the drug delivery systems of theinvention may further comprise at least one additional pharmaceuticallyactive agent.

The delivery systems of the invention may generally comprise a bufferingagent, an agent which adjusts the osmolarity thereof, and optionally,one or more pharmaceutically acceptable carriers, excipients and/oradditives as known in the art. Supplementary pharmaceutically acceptableactive ingredients can also be incorporated into the compositions. Thecarrier can be solvent or dispersion medium containing, for example,water, ethanol, polyol (for example, glycerol, propylene glycol, andliquid polyethylene glycol, and the like), suitable mixtures thereof,and vegetable oils. The proper fluidity can be maintained, for example,by the use of a coating, such as lecithin, by the maintenance of therequired particle size in the case of dispersion and by the use ofsurfactants.

As used herein “pharmaceutically acceptable carrier” includes any andall solvents, dispersion media, coatings, antibacterial and antifungalagents and the like. The use of such media and agents for pharmaceuticalactive substances is well known in the art. Except as any conventionalmedia or agent is incompatible with the active ingredient, its use inthe therapeutic composition is contemplated. It is contemplated that theactive agent can be delivered by any pharmaceutically acceptable routeand in any pharmaceutically acceptable dosage form.

Oral forms include, but are not limited to, tablets, capsules, pills,sachets, lozenges, drops, powders, granules, elixirs, tinctures,suspensions, syrups, and emulsions. Also included are oralrapid-release, time controlled-release, and delayed-releasepharmaceutical dosage forms. The active drug components can beadministered in a mixture with suitable pharmaceutical diluents,excipients or carriers (collectively referred to herein as “carrier”),materials suitably selected with respect to the intended form ofadministration.

Where the delivery system is for oral administration and is in the formof a tablet or capsule or the like, the active drug components can becombined with a non-toxic pharmaceutically acceptable inert carrier suchas lactose, starch, sucrose, glucose, modified sugars, modifiedstarches, methylcellulose and its derivatives, dicalcium phosphate,calcium sulfate, mannitol, sorbitol, and other reducing and non-reducingsugars, magnesium stearate, stearic acid, sodium stearyl fumarate,glyceryl behenate, calcium stearate and the like. For oraladministration in liquid form, the active drug components can becombined with non-toxic pharmaceutically acceptable inert carriers suchas ethanol, glycerol, water and the like. When desired or required,suitable binders, lubricants, disintegrating agents and coloring andflavoring agents can also be incorporated into the mixture. Stabilizingagents such as antioxidants, propyl gallate, sodium ascorbate, citricacid, calcium metabisulphite, hydroquinone, and 7-hydroxycoumarin canalso be added to stabilize the dosage forms. Other suitable compoundscan include gelatin, sweeteners, natural and synthetic gums such asacacia, tragacanth, or alginates, carboxymethylcellulose, polyethylene,glycol, waxes and the like.

Additional suitable pharmaceutically acceptable carriers that may beused in these pharmaceutical compositions include, but are not limitedto, ion exchangers, alumina, aluminum stearate, magnesium stearate,lecithin, serum proteins, such as human serum albumin, buffer substancessuch as phosphates, glycine, sorbic acid, potassium sorbate, partialglyceride mixtures of saturated vegetable fatty acids, water, salts orelectrolytes, such as protamine sulfate, disodium hydrogen phosphate,potassium hydrogen phosphate, sodium chloride, zinc salts, colloidalsilica, magnesium trisilicate, polyvinyl pyrrolidone, cellulose-basedsubstances, polyethylene glycol, sodium carboxymethylcellulose,polyacrylates, waxes, polyethylene-polyoxypropylene-block polymers,polyethylene glycol and wool fat. In some embodiments, thepharmaceutically acceptable carrier is magnesium stearate. Additionalpharmaceutical excipients commonly accepted and used are found in, forexample, Remington's Pharmaceutical Sciences (Gennaro, A., ed., MackPub., 1990).

For purposes of parenteral administration, solutions in suitable oilsuch as sesame or peanut oil or in aqueous propylene glycol can beemployed, as well as sterile aqueous solutions of the correspondingwater-soluble salts. Such aqueous solutions may be suitably buffered, ifnecessary, and the liquid diluent first rendered isotonic withsufficient saline or glucose. These aqueous solutions are especiallysuitable for intravenous, intramuscular, subcutaneous andintraperitoneal injection purposes. In this connection, the sterileaqueous media employed are all readily obtainable by standard techniqueswell-known to those skilled in the art. Methods of preparing variouspharmaceutical compositions with a certain amount of active ingredientare known, or will be apparent in light of this disclosure, to thoseskilled in this art.

The half-life of metadoxine in human serum is very short. Lu Yuan et al.(Chin. Med. J. 2007 120(2) 160-168) shows a mean half life of about 0.8hour. A way of prolonging serum levels of active moiety is byadministering the material in a sustained-release formulation. Becausemetadoxine is freely soluble in water and in various biological fluids(see Example 1), it is difficult to sustain its release and prolong itsabsorption time. Therefore, it was unexpected that sustained releasecould be achieved. A control release dosage form of metadoxine may bebased on a predetermined gradual release of the active ingredient in thebiological fluids, resulting in a sustained action with smallfluctuations of the plasma level over a prolonged period of time.

In certain embodiments, the delivery system of this invention may beadministered in controlled release formulations. In certain embodiments,the method of administration will be determined by the attendingphysician or other person skilled in the art after an evaluation of thesubject's condition and requirements. An embodiment of the method of thepresent invention is to administer the therapeutic compound describedherein in a sustained release form. Any controlled or sustained releasemethod known to those of ordinary skill in the art may be used with thecompositions and methods of the invention such as those described inLanger, Science 249(4976):1527-33 (1990). Such method comprisesadministering a sustained-release composition, a suppository, or acoated implantable medical device so that a therapeutically effectivedose of the composition of the invention is continuously delivered to asubject of such a method. Sustained release may also be achieved using apatch designed and formulated for the purpose. The composition of theinvention may be delivered via a capsule which allows sustained-releaseof the agent over a period of time. Controlled or sustained-releasecompositions include formulation in lipophilic depots (e.g., fattyacids, waxes, oils). Also comprehended by the invention are particulatecompositions coated with polymers (e.g., poloxamers or poloxamines).Sustained release formulae or devices, or any topical formulations, mayadditionally contain compositions to stabilize the composition orpermeate physiological barrier such as skin or mucous membrane.Exemplary additional components may include any physiologicallyacceptable detergent, or solvent such as, for example, dimethylsulfoxide(DMSO).

In certain embodiments, the metadoxine in compositions of the inventionmay be formulated for sustained or controlled release over a period ofat least 0.5, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11 or 12 hours. In certainembodiments, the metadoxine in compositions of the invention may beformulated for sustained or controlled release over a period of about0.5, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11 or 12 hours. In certainembodiments, the metadoxine in compositions of the invention may beformulated for sustained or controlled release over a period of betweenabout 0.5 or 1 or 2 or 3 or 4 hours and about 5, 6, 7, 8, 9, 10, 11 or12 hours. In certain embodiments, the metadoxine in compositions of theinvention may be formulated for sustained or controlled release over aperiod of between about 5 or 6 or 7 or 8 hours and about 9, 10, 11 or 12hours.

In certain embodiments, the metadoxine in compositions of the inventionmay be in immediate, fast of burst release form.

In certain embodiments, the metadoxine in compositions of the inventionmay be formulated to release up to 5, 10, 15, 20, 25, 30, 35, 40, 45,50, 55, 60, 65, 70, 75, 80, 85, 90, 95, 99, 99.5 or 100% of the totalmetadoxine in about 0.5, 1, 2, 3, 4, 5, 6, 7 or 8 hours. In certainembodiments, the metadoxine in compositions of the invention may beformulated to release not less than 5, 10, 15, 20, 25, 30, 35, 40, 45,50, 55, 60, 65, 70, 75, 80, 85, 90, 95, 99, 99.5 or 100% of the totalmetadoxine in about 0.5, 1, 2, 3, 4, 5, 6, 7 or 8 hours.

In certain embodiments, the metadoxine in compositions of the inventionmay be in a combination of sustained or slow release and immediate orfast release forms. In certain embodiments, the relative proportion ofsustained or slow release metadoxine to immediate or fast releasemetadoxine is, e.g., 1 to 99, 5 to 95, 10 to 90, 15 to 85, 20 to 80, 25to 75, 30 to 70, 35 to 65, 40 to 60, 45 to 55, 50 to 50, 55 to 45, 60 to40, 65 to 35, 70 to 30, 75 to 25, 80 to 20, 85 to 15, 90 to 10, 95 to 5,or 99 to 1.

In certain embodiments, a polymeric material is used to sustain orcontrol release of metadoxine. In certain embodiments, the type ofpolymeric material and the amount of which is used, have a stronginfluence on the rate of release of metadoxine from the product of thepresent invention. Examples of polymers include both hydrophobic andhydrophilic polymers. Examples of hydrophobic polymers include, but arenot limited to, ethyl cellulose and other cellulose derivatives, fatssuch as glycerol palmito-stereate, beeswax, glycowax, castorwax,camaubawax, glycerol monostereate or stearyl alcohol, hydrophobicpolyacrylamide derivatives and hydrophobic methacrylic acid derivatives,as well as mixtures of these polymers. Hydrophilic polymers include, butare not limited to, hydrophilic cellulose derivatives such as methylcellulose, hydroxypropylmethyl cellulose, hydroxyethylcellulose,hydroxypropyl cellulose, carboxymethyl cellulose, sodiumcarboxymethylcellulose and hydroxyethyl methylcellulose polyvinylalcohol, polyethylene, polypropylene, polystyrene, polyacrylamide,ethylene vinyl acetate copolymer, polyacrylate, polyurethane,polyvinylpyrrolidone, polymethylmethacrylate, polyvinyl acetate,polyhydroxyethyl methacrylate, as well as mixtures of these polymers.Furthermore, any mixture of one or more hydrophobic polymer and one ormore hydrophilic polymer could optionally be used.

In certain embodiments, a polymeric material to be used in compositionsof the invention is microcrystalline cellulose such as “Avicel PH 101”manufactured by FMC BioPolymer's.

In certain embodiments, a polymeric material to be used in compositionsof the invention is Hydroxypropyl Methylcellulose such as “Metholose”produced by Shin-Etsu Chemical Co.

In certain embodiments, a polymeric material to be used in compositionsof the invention is Ethyl cellulose such as “Ethocel™” manufactured byThe Dow Chemical Company.

In certain embodiments, a polymeric material to be used in compositionsof the invention is an acrylic polymer such as “Eudragit RS™” producedby Rohm GmbH.

In certain embodiments, a polymeric material to be used in compositionsof the invention is a colloidal silicone dioxide such as “Aerosil™”manufactured by Degussa.

In certain embodiments, a polymeric material to be used in compositionsof the invention is a Poly (Vinyl Acetate) such as “Kollicoat SR”manufactured by BASF.

In certain embodiments, a polymeric material to be used in compositionsof the invention is an Ethyl Acetate and Vinyl Acetate solution such as“Duro-Tak” manufactured by Delasco Dermatologic Lab & Supply, Inc.

In certain embodiments, the composition of the invention comprises orconsists essentially of Formula 1. Formula 1 comprises or consistsessentially of 100-3000 mg metadoxine and 5-20,000 mg metholose.

In certain embodiments, the composition of the invention comprises orconsists essentially of Formula 2. Formula 2 comprises or consistsessentially of 100-3000 mg metadoxine and 5-7000 mg Ethocel E10™.

In certain embodiments, the composition of the invention comprises orconsists essentially of Formula 3. Formula 3 comprises or consistsessentially of 100-3000 mg metadoxine and 5-20,000 mg Eudragit RS™.

In certain embodiments, the compositions of the invention comprise orconsist essentially of about 250, 300, 400, 500, 600, 700, 800, or 900mg to about 1000, 1500, 2000, 2500 or 3000 mg metadoxine. In certainembodiments, the compositions of the invention comprise or consistessentially of about 5, 100, 500, or 1000 mg to about 2000 4000, 10,000,15,000, or 20,000 mg Avicel PH 101™. In certain embodiments, thecompositions of the invention comprise or consist essentially of about25, 50, 100, 150, 200, 250, 300, 350, 400, 450, 500, 550 or 600 mg toabout 650, 700, 750, 800, 850, 900, 950, 1000, 5000, 10,000, 15,000 or20,000 mg of a polymeric material. In certain embodiments, the polymericmaterial is metholose, Ethocel E10™ or Eudragit RS™. In certainembodiments, metholose comprises or consists essentially of between 1and 90% of the formulation, preferably between 5 and 70%. In certainembodiments, Ethocel™ comprises or consists essentially of between 1 and30% of the formulation, preferably between 2 and 20%. In certainembodiments, Eudragit™ comprises or consists essentially of between 1and 90% of the formulation, preferably between 5 and 70%.

In certain embodiments, delivery systems of the invention comprisedelivery devices. In certain embodiments, the compositions of theinvention are delivered by an osmotic process at a controlled rate suchas by an osmotic pump. The system may be constructed by coating anosmotically active agent with a rate controlling semipermeable membrane.This membrane may contain an orifice of critical size through whichagent is delivered. The dosage form after coming into contact withaqueous fluids, imbibes water at a rate determined by the fluidpermeability of the membrane and osmotic pressure of the coreformulation. This osmotic imbibitions of water result in formation of asaturated solution of active material with in the core, which isdispensed at controlled rate from the delivery orifice in the membrane.

In certain embodiments, the compositions of the invention are deliveredusing biodegradable microparticles. In certain embodiment, the system toprepare microparticles consists of an organic phase comprised of avolatile solvent with dissolved polymer and the material to beencapsulated, emulsified in an aqueous phase. In certain embodiments,the biodegradable polymers that can be used for the microparticlematrix, comprises polylactic acid (PLA) or the copolymer of lactic andglycolic acid (PLAGA). The PLAGA polymer degrades hydrolytically overtime to its monomeric components, which are easily removed from the bodythrough natural life processes.

The preparation may also contain an absorption enhancer and otheroptional components. Examples of absorption enhancers include, but arenot limited to, are cyclodextrins, phospholipids, chitosan, DMSO, Tween,Brij, glycocholate, saponin, fusidate and energy based enhancingabsorption equipment.

Optional components present in the dosage forms include, but are notlimited to, diluents, binders, lubricants, surfactants, coloring agents,flavors, buffering agents, preservatives, stabilizing agents and thelike.

Diluents, also termed “fillers” include, for example, dicalciumphosphate dihydrate, calcium sulfate, lactose, cellulose, kaolin,mannitol, sodium chloride, dry starch, hydrolyzed starches, silicondioxide, colloidal silica, titanium oxide, alumina, talc,microcrystalline cellulose, and powdered sugar. For administration inliquid form, the diluents include, for example, ethanol, sorbitol,glycerol, water and the like.

Binders are used to impart cohesive qualities to the formulation.Suitable binder materials include, but are not limited to, starch(including corn starch and pregelatinized starch), gelatin, sugars(including sucrose, glucose, dextrose, lactose and sorbitol),polyethylene glycol, waxes, natural and synthetic gums, e.g., acacia,tragacanth, sodium alginate, celluloses, and Veegum, and syntheticpolymers such as polymethacrylates and polyvinylpyrrolidone.

Lubricants are used to facilitate manufacture; examples of suitablelubricants include, for example, magnesium stearate, calcium stearate,stearic acid, glyceryl behenate, and polyethylene glycol.

Surfactants may be anionic, cationic, amphoteric or nonionic surfaceactive agents, with anionic surfactants preferred. Suitable anionicsurfactants include, but are not limited to, those containingcarboxylate, sulfonate and sulfate ions, associated with cations such assodium, potassium and ammonium ions. Particularly preferred surfactantsinclude, but are not limited to: long alkyl chain sulfonates and alkylaryl sulfonates such as sodium dodecylbenzene sulfonate; dialkyl sodiumsulfosuccinates, such as sodium bis-(2-ethylhexyl)-sulfosuccinate; andalkyl sulfates such as sodium lauryl sulfate.

Stabilizing agents such as antioxidants, include, but are not limitedto, propyl gallate, sodium ascorbate, citric acid, calciummetabisulphite, hydroquinone, and 7-hydroxycoumarin.

If desired, the present compositions may also contain minor amounts ofnontoxic auxiliary substances such as wetting or emulsifying agents,preservatives, and the like.

Any of the compositions of the invention may be used alone or incombination with one or more additional therapeutic agents, for thetreatment of alcohol consumption related symptoms. For examples ofadditional therapeutic agents see U.S. Patent Application PublicationNos. 2005/0271739, 2004/0162270 and 2002/0192303, herein incorporated byreference in their entirety.

The amount of both the compound and the additional therapeutic agentthat may be combined with the carrier materials to produce a singledosage form will vary depending upon the host treated and the particularmode of administration. Preferably, the compositions of this inventionshould be formulated so that a dosage of between 0.1-1 g/kg bodyweight/day, preferably 0.1-300 mg/kg body weight, can be administered.The dose of the compound depends on the condition and the illness of thepatient, and the desired daily dose. In human therapy, the oral dailydose is preferably 10-3000 mg. These doses are administered in unitdosage forms, which may be divided into 2-3 smaller doses for each dayin certain cases, especially in oral treatment.

In certain embodiments, the compositions of the present invention mayact synergistically in combination with each other and may further actsynergistically in the presence of an additional therapeutic agent.Therefore, the amount of compound(s) and additional therapeutic agent(s)in such compositions will be less than that required in a monotherapyutilizing only that therapeutic agent. In such compositions a dosage ofbetween 0.1-1 g/kg bodyweight/day of the additional therapeutic agentcan be administered.

Use of Metadoxine to Prepare Therapeutic Compositions

In certain embodiments, the present invention provides a use ofmetadoxine (or a functional, physiologically acceptable derivative ofmetadoxine) in the manufacture of a therapeutic composition useful foradministering to a subject in need thereof according to any one of themethods of the invention as described herein. In certain embodiments,the present invention provides a use of metadoxine (or a functional,physiologically acceptable derivative of metadoxine) in the manufactureof a therapeutic composition useful for administering to a subject inneed thereof according to any one of the compositions of the inventionas described herein.

Kits and Delivery Devices

The present invention also provides delivery devices and kits comprisinga metadoxine composition of the invention, and methods for their use.Delivery devices and kits of the invention may be used for practicingeach of the methods of the invention as described herein, e.g., forreducing or preventing symptoms or effects of alcohol consumption; forpreventing alcohol intoxication; for reducing or eliminating bloodalcohol levels in a subject, or for increasing the mean t_(max) ofmetadoxine in the blood of a subject, among others.

In certain embodiments of this invention, kits and delivery devices ofthis invention may be included in a container, package or dispenseralone or as part of a kit with labels and instructions foradministration. In certain embodiments of this invention, components forperforming methods of this invention may be included in a container,package or dispenser alone or as part of a kit with labels andinstructions for administration. In certain embodiments, the componentsmay include means for measuring or monitoring BAC levels before, duringor after administration of a metadoxine composition. Measuring ormonitoring BAC levels is performed by conventional means known to one ofordinary skill in the art.

Delivery devices for use with the compositions and methods of theinvention may include any devices for drug delivery known to one ofordinary skill in the art. In certain embodiments, delivery devices areused to maintain sustained or controlled release of the compositions ofthe invention.

EXAMPLES

The following examples are intended to be illustrative of the disclosedinvention. The examples are non-limiting, and the skilled artisan willrecognize that other embodiments are within the scope of the presentinvention. Where not otherwise noted, methods were performed usingtechniques that would be understood by one of ordinary skill in the art.

Example 1 Solubility Testing of Metadoxine

200 mg of metadoxine powder were weighted into 4 test tubes. For eachtest tube 2 g of one aqueous medium was added. Media tested wereDulbecco's PBS pH 7.2, simulated gastric fluid without pepsin USP (SGFpH 1.2), phosphate buffer 10 mM pH 4.5 and simulated intestinal fluidwithout pancreatin USP (SIF pH 6.8). The material was fully dissolved inall four aqueous media. Additional amount of metadoxine powder was addedin 200 mg portions until maximal weight of 1.4 g was achieved.

Results:

Metadoxine (1.4 g) was dissolved in 2 g of each medium. The finalconcentration (w/w) was 70%.

Conclusion:

Metadoxine is freely soluble in various biological fluids.

Example 2 Immediate Release Tablets of Metadoxine

500 mg tablets were prepared using the same ingredients as thecommercial product: microcrystalline cellulose and magnesium stearate.

Metadoxine 500 milligrams Avicel PH 101 ™ 100 milligrams Magnesiumstearate  14 milligrams

Materials were mixed together and compressed into tablets. Dissolutionwas tested using USP apparatus 2 (paddles), 50 rpm, 500 ml intestinalfluid pH=6.8, 37° C. Tablets dissolved immediately reaching 100% after30 minutes (see FIG. 1).

Example 3 Slow Release Tablets of Metadoxine

500 mg tablets were prepared using same ingredients as the commercialproduct plus matrix forming polymer. Polymer selection is important toachieving slow release of this highly soluble molecule. This polymerswallows in aqueous media and forms a viscous gel which releases theactive material slowly.

Metadoxine 500 milligrams Avicel PH 101 ™  72 milligrams Metholose 90SH250 milligrams Magnesium stearate  21 milligrams

Materials were mixed together and compressed into tablets. Dissolutionwas tested using USP apparatus 2 (paddles), 50 rpm, 500 ml intestinalfluid pH=6.8, 37° C. Tablets dissolved slowly reaching 74% after 6 hours(see FIG. 1).

Example 4 Slow Release Capsules of Metadoxine

Granules were prepared using high shear granulation and vacuum drying.The choice of granulation solvent is important since it has to dissolvethe polymer and not the active material.

Metadoxine 250 milligrams per capsule Avicel PH 101 ™ 51.5 milligramsper capsule Metholose 90SH  125 milligrams per capsule

Materials were mixed together and granulated with the aid of ethanol.Granules were filled inside gelatin capsules. Dissolution was testedusing USP apparatus 2 (paddles), 50 rpm, 500 ml intestinal fluid pH=6.8,37° C. Granules dissolved slowly reaching 75% after 4 hours (see FIG.2).

Example 5 Slow Release Capsules of Metadoxine

Granules were prepared using high shear granulation and vacuum drying.The dissolution of this composition is by diffusion.

Metadoxine  250 milligrams per capsule Avicel PH 101 ™ 83.5 milligramsper capsule Ethocel E10 ™ 36.5 milligrams per capsule

Materials were mixed together and granulated with the aid of ethanol.Granules were filled inside gelatin capsules. Dissolution was testedusing USP apparatus 2 (paddles), 50 rpm, 500 ml intestinal fluid pH=6.8,37° C. Granules dissolved slowly reaching 85% after 4 hours (see FIG.2).

Example 6 Slow Release Capsules of Metadoxine

Granules were prepared using high shear granulation and vacuum drying.This is an example of an acrylic hydrophobic polymer as a polymericmaterial.

Metadoxine 250 milligrams per capsule  Avicel PH 101 ™ 90 milligrams percapsule Eudragit RS ™ 46 milligrams per capsule

Materials were mixed together and granulated with the solution ofEudragit RS™ solution in ethanol. Granules were filled inside gelatincapsules. Dissolution was tested using USP apparatus 2 (paddles), 50rpm, 500 ml intestinal fluid pH=6.8, 37° C. Granules dissolved slowlyreaching 100% after 2 hours (see FIG. 2).

Example 7 Controlled Release Syrup of Metadoxine

Syrup is prepared using an overhead rotary mixer.

Metadoxine granules 950 milligrams per 5 milliliters Strawberry Flavor 20 milligrams per 5 milliliters Sorbitol 70% Solution to completevolume of 5 milliliters

Metadoxine slow release granules (from Example 5) are mixed in Sorbitol70% solution. Strawberry Flavor is added.

Example 8 Ready to Swallow Sachets of Metadoxine

Two granulations are performed in a mixer granulator:

Granules No 1:

Metadoxine 600 milligrams Cyclodextrine 500 milligramsGranules No 2:

Metadoxine 800 milligrams Metholose 90SH 200 milligrams Ethocel E10 ™ 50 milligramsFinal Mix:

Magnesium Stearate 10 milligrams Aerosil 200 ™ 10 milligrams

Granules No 1 (enhanced absorption formula) and Granules No 2 (slowrelease formula) are mixed together with other ingredients and filledinside sachets.

Example 9 Metadoxine Ice Cream

Micro granules (pellets) are prepared using extrusion technology:

Metadoxine 2500 milligrams Mannitol  200 milligrams Ethocel E10 ™  50milligrams

Pellets are coated in a Wurster Fluidized Bed Dryer.

Kollicoat SR 30D 200 milligrams

Pellets are mixed with ice cream and delivered as chocolate coated icecream cubes.

Example 10 Dermal Patch of Metadoxine

Materials (below) are mixed together to form a clear gel. The gel iscoated onto a backing membrane by using coating equipment. The laminateis dried and a polyester release liner is laminated onto the driedmetadoxine gel. The sheet is cut into patches and stored in a coolplace.

Metadoxine 2300 milligrams Durotak 387-2287  200 milligrams Ethanol  10milliliters Water   5 milliliters

Example 11 Metadoxine Chocolate Bar

Micro granules (pellets) are prepared using extrusion technology:

Metadoxine 2000 milligrams Ethocel E10 ™  70 milligrams

Pellets are mixed with

Metadoxine 1000 milligrams

The mixture is incorporated inside melt chocolate bar.

Example 12 Metadoxine Effervescent Candy

Micro granules (pellets) are prepared using extrusion technology:

Metadoxine 70 milligrams Metholose 90SH 35 milligrams

Pellets are mixed with

Metadoxine 60 milligrams

Sodium bicarbonate 60 milligrams

Citric acid 100 milligrams  Sucralose 20 milligrams Cherry flavor 10milligrams

The mixture is filled inside Sachets.

Example 13 Pharmacokinetic Study in Pigs

A three-way crossover bioavailability test after a single oraladministration to three fasting healthy pigs was performed. One arm ofthe study involves 250 mg immediate release capsules—as a study control(same as current marketed formulation). The second arm of the studyinvolves 250 mg slow-release capsules—test formulation. The third arm ofthe study involves intake of two 250 mg slow-release capsules (500mg)—test formulation. The aim of this arm was to establish the optimaldose for the slow-release delivery. Usually, slow-release formulationscontain higher dose than immediate release formulations and are givenless frequently.

A total of 3 commercial pigs, 15-18 kg body-weight were treated. Thepigs fasted 36 hours before the experiment excluding liquid food 24hours before the experiment. The animals received the drugs orallyaccording to the treatment arms. 3 ml of Blood were drawn into EDTAtubes before treatment and at 20′, 40′ 1 hr, 2 hr, 4 hr, 8 hr and 24 hrafter drug administration. Blood was centrifuged, serum collected andfrozen. Serum was analyzed for metadoxine content using a sensitivespecific HPLC method.

The results show that time to peak (t_(max)) of the slow-releaseformulation is delayed (about 2 hours compared to about 1 hour of theimmediate release formulation) (FIG. 3; Table 1). Area under the curve(AUC) of both formulations are similar (Table 1). When a double dose wasgiven the t_(max) is delayed to the same extent as the slow-releasesingle dose, however, AUC was doubled (FIG. 4; Table 1).

TABLE 1 AUC Cmax Tmax Formulation (μg/h * ml) (μg/ml) (h) Immediate 32.88.7 1 release Slow release 34.9 8.9 2 Slow release x2 69.0 18.2 2

Example 14 Pharmacokinetic Study in Human Subjects

A randomized three-way crossover comparative bioavailability study, withhealthy fasting subjects receiving single doses of metadoxineformulations on three occasions separated by at least 3 days washoutperiod is performed. One arm of the study involves 500 mg immediaterelease tablets—as a study control (same as current marketedformulation). The second arm of the study involves 500 mg slow-releasetablets—test formulation. The third arm of the study involves intake oftwo 500 mg slow-release tablets (1000 mg)—test formulation. Bloodsamples are collected following a predetermined time schedule in eachperiod in order to characterise drug absorption and elimination.

Subjects arrive in the morning, after an overnight fasting (at least 10hours). Each subject is assigned a subject number, which is used forallocation to treatment groups. A baseline (time 0) blood specimen isobtained by aseptic venipuncture. Then each subject ingests a singledose of metadoxine, either a test or a reference product as outlinedabove, with 200 ml tap water. Venous blood (6 ml each) is then drawn(anticoagulated with EDTA) at 0.5, 0.75, 1, 1.5, 2, 2.5, 3, 4, 5, 6, 8,10, 12 and 24 hours post dosing (total of 15 in each period). Each bloodspecimen is identified by a label specifying the study number, subject#, period and sample #. Blood samples are immediately handled andseparated by centrifugation and the plasma aliquoted into 3 sets of testtubes and frozen at −75° C. (nominal) for analysis of metadoxineconcentrations. Following at least a 3 day washout between periods, theprocedure is repeated with each subject being dispensed an alternateproduct.

Human results are expected to be similar to the pigs' results of Example13. t_(max) of the slow-release formulation is delayed and AUC of bothformulations are similar. When a double dose is given the t_(max) isdelayed to the same extent as the slow-release single dose, however, AUCis doubled.

While some embodiments of the invention have been described by way ofillustration, it will be apparent that the invention can be put intopractice with many modifications, variations and adaptations, and withthe use of numerous equivalents or alternative solutions that are withinthe scope of persons skilled in the art, without departing from thespirit of the invention or exceeding the scope of the claims.

All publications, patents and patent applications are hereinincorporated by reference in their entirety to the same extent as ifeach individual publication, patent or patent application wasspecifically and individually indicated to be incorporated by referencein its entirety.

The invention claimed is:
 1. A method for increasing the mean t_(max) ofmetadoxine in the blood of a subject in need thereof comprisingadministering a composition for oral administration comprising as theactive ingredient metadoxine, wherein a portion of the metadoxine isformulated for sustained release and a portion of the metadoxine isformulated for immediate release, and wherein the relative proportion ofthe sustained release metadoxine portion to the immediate releasemetadoxine portion is in the range of from 60:40 to 80:20, in wholeintegers.
 2. The method according to claim 1, wherein said compositionhas a t_(max) of metadoxine in the blood that is about 2-fold greaterthan in an immediate release composition.
 3. The method according toclaim 1 or 2, wherein said composition is administered by non-chronicadministration.
 4. The method according to claim 3, wherein saidcomposition is administered in a single dosage form or portion thereof.5. The method of claim 1, wherein the total amount of the metadoxine ineach portion is between about 100 and 3000 mg.
 6. The method of claim 1,wherein the sustained release portion provides for release of themetadoxine for at least 8 hours.
 7. The method of claim 1, wherein thetotal amount of the metadoxine in each portion is between 500 and 1500mg.
 8. The method of claim 1, wherein the relative proportion of thesustained release metadoxine portion to the immediate release metadoxineportion is about 65:35.
 9. The method of claim 1, wherein the sustainedrelease metadoxine portion is formulated with a combination ofhydroxypropylmethyl cellulose and ethylcellulose.
 10. The method ofclaim 1, wherein the composition further comprises at least one of apolymeric material, an absorption enhancer, and an acceptable excipient.